实时三维超声及组织多普勒显像评价先心病肺动脉高压患者的右心功能

目的探讨实时三维超声及组织多普勒评价先天性心脏病合并肺动脉高压（PAH）患者右心功能的临床价值。方法先天性心脏病合并PAH患者（PAH组）24例，其中PAH轻度组10例，中度组8例，重度组6例；正常对照组16例。术前实时三维超声测量右室舒张末容量、收缩末容量，计算右室射血分数，组织多普勒测量三尖瓣环处游离壁组织收缩期速度及舒张早期、舒张晚期运动速度。结果①与对照组比较，PAH组右室舒张末容量、收缩末容量增大，射血分数减低（P〈0．01）。②随着肺动脉压力升高，心功能呈逐渐下降趋势；右心室三维容积曲线逐渐低平，收缩峰值后移。③三尖瓣环运动速度在重度肺动脉压力时下降。结论实时三维超声及三尖瓣环运动速度能有效评估右室整体功能，对于先天性心脏病患者的手术治疗及预后评价有重要意义。

Evaluation of right ventricular function in patients of congenital heart disease combined with pulmonary artery hypertension using tissue Doppler imaging and real time three dimensional echocardiography

Objective To investigate the value of real-time three-dimensional echocardiography and tissue Doppler imaging in congenital heart disease（CHD）. Methods 24 patients with congenital heart diseases combined with pulmonary artery hypertension （PAH） confirmed by surgery and 16 normal objects were enrolled in this study. Full volume images were obtained on RT-3DE in all the subjects. The end-diastolic volume, end-systolic volume, ejection fraction of the right ventricle, fight ventricular peak systolic velocity（Vs） and peak early diastolic systolic velocity（Ve） and peak late diastolic systolic velocity（Va） of fight ventricular lateral side of tricuspid annulus were determined. Comparison of RVESV RVEDV EF Ve Vs Va changes between the groups was performed. Results Compared with the control group , RVEDV, RVESV were increased significantly and EF was decreased in PAH group. Right ventricular regional volume showed a gradual downward trend with PAH. Ve, Vs were significantly decreased and Va was increased in PAH group. Conclusion The RT-3DE and tissue velocity imaging are new technologies in evaluating global fight ventricnlar systolic function. It can help to choose an optimal method and to evaluate the prognosis more precisely.